Comparative Effectiveness Research at AHRQ: The Effective Health Care Program

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Comparative Effectiveness Research at AHRQ The
Effective Health Care Program

• Jean Slutsky
• Center for Outcomes and Evidence
• SACME Spring 2009

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Hospital Performs New Heartburn Technique

• ''This is an exciting area for development,'' he
  said. ''What's not clear right now is which of
  the different approaches -- and there are several
  -- is going to win out.''
• He said that parallel methods under development
  for repairing the esophagus valve from the inside
  include thickening it by injections, or by
  causing it to scar, as well as various techniques
  of stapling it or suturing it from the inside, as
  in Maastricht. It is not yet clear which is best.

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Hospital Performs New Heartburn Technique

• ''Time will tell,'' Brandt said.
• The procedure has previously been tested in two
  sets of 20 European patients, but Friday's
  surgeries were the first in commercial use. The
  procedure will be introduced in 30 hospitals
  around Europe this year.
• NYT 6/19/06

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The Effective Health Care Challenge
What Is Quality?
The Right Care
For The Right Person
At The Right Time
A Quality Disconnect
Health care costs up 6.7 per year
Health care quality up 2.3
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Comparative Effectiveness a rigorous
evaluation of the impact of different options
that are available for treating a given medical
condition for a particular set of patients.
CBO, 2007
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AHRQs Role in Comparative Effectiveness

• Lead USA national agency for comparative
  effectiveness research
• Health technology assessment at the request of
  the Centers for Medicare and Medicaid Services
• Analyze data/options for Coverage with Evidence
  Development (CED) and post CED data collection
• Provide translation of comparative effectiveness
  findings
• Promote and fund comparative effectiveness
  methods research
• Fund training grants focused on comparative
  effectiveness

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Comparative Effectiveness Research at AHRQ

• Created in 2005, authorized by Section 1013 of
  the Medicare Prescription Drug, Improvement, and
  Modernization Act (MMA) of 2003
• AHRQ shall conduct and support research on
• the outcomes, comparative clinical
  effectiveness, and appropriateness of health care
  items and services (including prescription
  drugs)
• Goal to provide patients, clinicians and policy
  makers with reliable, evidence-based healthcare
  information

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American Recovery and Reinvestment Act and CER

• 1.1 B for comparative effectiveness research
• AHRQ 300M
• NIH 400M (appropriated to AHRQ and transferred
  to NIH)
• Office of the Secretary 400M (allocated at the
  Secretarys discretion)
• Funds are available through September 30, 2010

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AHRQs CER Role under ARRA

• AHRQ to continue its CER work under the auspices
  of section 1013 of MMA
• AHRQ will continue to have a collaborative, open,
  and transparent process for comparative
  effectiveness that allows for input from all
  perspectives.
• AHRQ will continue to involve all stakeholders in
  the research process.
• To determine what priorities and projects will be
  funded under this new authority, we are
  undertaking a process to determine what will be
  funded, working with the Office of the Secretary,
  NIH, and IOM. We also will be seeking external
  input as AHRQ has done in the past.

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Effective Health Care Program

• To improve the quality, effectiveness, and
  efficiency of health care delivered through
  Medicare, Medicaid, and S-CHIP programs
• Focus is on what is known now ensuring programs
  benefit from past investments in research and
  what research gaps are critical to fill
• Focus is on clinical effectiveness

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Priority Conditions for the Effective Health Care
Program

• Arthritis and non-traumatic joint disorders
• Cancer
• Cardiovascular disease, including stroke and
  hypertension
• Dementia, including Alzheimer Disease
• Depression and other mental health disorders
• Developmental delays, attention-deficit
  hyperactivity disorder and autism

• Diabetes Mellitus
• Functional limitations and disability
• Infectious diseases including HIV/AIDS
• Obesity
• Peptic ulcer disease and dyspepsia
• Pregnancy including pre-term birth
• Pulmonary disease/Asthma
• Substance abuse

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Conceptual Framework
Stakeholder Input Involvement
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Impact of Stakeholders

• Increased transparency
• Comment periods
• Online comments
• Increased access
• E-mail notifications
• Web site design
• Improved product formats
• Executive summaries
• Consumer guides
• Clinician guides
• Improved methods
• Working documents on Web site (Oct 2007)
• Working groups on methods

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Important Role of Outside Input

• Nomination of research topics
• Input on research questions
• Comment on draft reports
• Focus test translation products
• Comments on overall program direction and quality
  improvement

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Conceptual Framework
Stakeholder Input Involvement
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Comparative Effectiveness Reviews Coming soon

• Comparative Effectiveness Reviews
• Stable Ischemic Heart Disease (draft report)
• Particle Beam Therapies for Cancer (Technical
  Brief)
• Stereotactic Radiosurgery (Technical Brief)
• Heart Valve Replacement (Technical Brief)
• Core NeedleBreast Biopsy
• Lipid-modifying Agents
• Radiofrequency Catheter Ablation for Atrial
  Fibrillation
• Chemotherapy Agents in the Prevention of Breast
  Cancer
• 9 Comparative Effectiveness Review Updates

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Conceptual Framework
Stakeholder Input Involvement
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DEcIDE Consortium and Pilots

• Diabetes Multi-Center Research Consortium
• Cancer Consortium
• Cardiovascular Disease Consortium
• Stakeholder driven - address identified research
  gaps

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DARTNet Distributed Ambulatory Research in
Therapeutics Network

• Federated network of electronic health data from
  9 physician organizations (over 500 clinicians
  and over 400,000 patients)
• Objectives of pilot study
• Create DARTNet and validate data and system
  integrity
• Evaluate comparative effectiveness, safety and
  utilization of oral hypoglycemics
• Assess factors affecting scale up (size and
  complexity) and sustainability of DARTNet

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HMORN Distributed Research Network Prototype

• Developing the architecture for a multi-purpose,
  multi-institutional, distributed health data
  network.
• Intended to support secure data analyses on data
  that remains in the possession of the original
  data holder.
• Research study involves three large, integrated
  healthcare delivery systems that collectively
  care for over 4 million people.
• Assessing the comparative effectiveness of two
  commonly used second-line antihypertensive
  agents angiotensin-converting enzyme (ACE)
  inhibitors and beta-blockers.

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Educating Clinicians

• Concise
• Actionable
• Paired with consumer guides
• Convey level of uncertainty/certainty of findings

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New and Coming soon

• Summary guides
• - Osteoarthritis of the Knee (consumer and
  clinician)
• - Gestational diabetes (consumer and
  clinician)
• - Induction of labor (consumer and
  clinician)
• - Particle beam (policymaker)
• Spanish translations of 6 summary guides

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Coming soon (cont.)
Interactive Decision Aids
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Opportunities

• Increased emphasis on using best available
  evidence for decision making
• Educational opportunities and the role of SACME
• Growing consensus on the importance of
  comparative effectiveness research in lifelong
  learning of professionals

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Thank You
http//effectivehealthcare.ahrq.gov